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Showing papers in "Journal of Psychoactive Drugs in 2001"


Journal ArticleDOI
TL;DR: A new critical review of the research on the impact on male and female sexual function of psychoactive drugs including alcohol, nicotine, and illicit drugs suggests that chronic alcohol and drug abuse have clear deleterious affects on sexual functioning for many individuals.
Abstract: The use of psychoactive substances is popularly believed to loosen sexual inhibitions and contribute to increased sexual activity. However, the actual direct and indirect effects of alcohol and drugs on sexual function are still not fully understood. This article provides a new critical review of the research on the impact on male and female sexual function of psychoactive drugs including alcohol, nicotine, and illicit drugs. The authors consider the effects of both acute and chronic use and review findings from controlled laboratory studies as well as survey and interview research. Research on the impact of substance use and abuse on human sexual function has some limitations due to small and nongeneralizable samples, lack of controlled research design or comparison groups, reliance on self-reported data, or failure to specify or control for dosage effects, expectancies, social effects, and multiple substance use. The lack of controls on physiological, psychological, environmental and cultural factors that could alter the relationship between substance use and sexual function also make it difficult to draw conclusions about direct causal mechanisms. Despite these limitations, this review suggests that chronic alcohol and drug abuse have clear deleterious affects on sexual functioning for many individuals.

244 citations


Journal ArticleDOI
TL;DR: The conclusions are that ketamine dependence is linked with effects that this complex drug has in common with not only cocaine and amphetamine but also with opiates, alcohol and cannabis, as well as the psychological attractions of its distinctive psychedelic properties.
Abstract: This is the second part of a review of the nonmedical use of ketamine. Part one discussed the history of ketamine, the sought-after effects for which it is taken in a nonmedical context, how these are produced, common adverse effects, the ketamine schizophrenia model and the neurotoxicity issue. Part two reviews what is currently known about problem use of ketamine, ketamine dependence, treatment options and harm minimization issues. Some ketamine users become dependent on the drug in a manner resembling cocaine dependence, with craving and a high tolerance but no evidence of a physiological withdrawal syndrome. The likely mechanisms of this dependence are discussed in terms of what is known about the neurochemistry of ketamine, its psychological effects, and published case histories in both the formal and informal literature. The conclusions are that ketamine dependence is linked with effects that this complex drug has in common with not only cocaine and amphetamine but also with opiates, alcohol and cannabis, as well as the psychological attractions of its distinctive psychedelic properties.

117 citations


Journal ArticleDOI
TL;DR: Strength of religious and spiritual support was a significant independent predictor of abstinence in HIV-positive injection drug users entering a methadone maintenance program.
Abstract: The current study examined the association between support and comfort derived from religion or spirituality and abstinence from illicit drugs in a sample of 43 HIV-positive injection drug users entering a methadone maintenance program. Patients with high ratings of perceived spiritual or religious support were abstinent from illicit drugs significantly longer during the first six months of methadone maintenance than were patients with lower ratings. Controlling for the influence of pretreatment variables (addiction and psychiatric severity, CD4 count, social support, and optimism), and during-treatment variables (methadone dose and attendance at counseling sessions), hierarchical regression analysis showed that strength of religious and spiritual support was a significant independent predictor of abstinence. These findings suggest that spirituality may be an important dimension of patient experience to assess in future addiction treatment outcome research.

115 citations


Journal ArticleDOI
TL;DR: Intranasal, sublingual and oral psychoactivity of 5-MeO-DMT, and the 1967 Holmstedt–Lindgren hypothesis of the paricá-effect—intran asal potentiation of tryptamines by concomitant administration of monoamine-oxidase-inhibiting (MAOI) β-carbolines from stems of Banisteriopsis caapi admixed with the snuffs—have been confirmed by some 17 psych
Abstract: Summarized are psychonautic bioassays (human self-experiments) of pharmepena--crystalline 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT; O-Me-bufotenine), at times combined with crystalline beta-carbolines (harmaline or harmine). These substances were administered via intranasal, sublingual and oral routes, by way of pharmacological modeling of diverse South American shamanic inebriants (principally the snuffs epena/nyakwana, prepared from barks of diverse species of Virola.) Intranasal, sublingual and oral psychoactivity of 5-MeO-DMT, and the 1967 Holmstedt-Lindgren hypothesis of the parica-effect--intranasal potentiation of tryptamines by concomitant administration of monoamine-oxidase-inhibiting (MAOI) beta-carbolines from stems of Banisteriopsis caapi admixed with the snuffs--have been confirmed by some 17 psychonautic bioassays. Salient phytochemical and psychonautic literature is reviewed.

89 citations


Journal ArticleDOI
TL;DR: Because of its tolerance of treatment goals other thatn abstinence, harm reduction therapy offers the greatest hope to expand the availability of substance abuse services to people who have not benefited from traditional abstinence-based treatment models.
Abstract: One-size-fits-all therapy has not worked well for a majority of substance users seeking help. New approaches to substance abuse treatment are desperately needed. Traditional models of service delivery offer little, if any, help to people who may not choose abstinence as a goal. To address this concern, the Bridging the Gap Conference was sponsored by the San Francisco Department of Public Health. The overall goals of the conference were to improve standards of care, develop best practice principles for integrating harm reduction approaches into traditional substance abuse services, and increase the accessibility of quality services to people in need of alcohol and drug treatment. G. Alan Marlatt gave a keynote address on the integration of harm reduction therapy into traditional treatment services, an expanded version of which is presented in this article. Such integration would broaden the scope of services available to a larger group of consumers of substance abuse treatment. Furthermore, harm reduction therapy would infuse traditional treatment practices with scientifically-based pragmatism that pays close attention to individual and community public health needs. Because of its tolerance of treatment goals other than abstinence, harm reduction therapy offers the greatest hope to expand the availability of substance abuse services to people who have not benefited from traditional abstinence-based treatment models.

88 citations


Journal ArticleDOI
TL;DR: The extent to which crack has remained primary in the culture of cocaine-dependent women is examined and implications for policy alternatives in criminal justice and public health approaches for assisting this population are discussed.
Abstract: The linkages between the sex-for-crack exchanges, prostitution, and rising rates of HIV and other sexually transmitted diseases among cocaine-dependent women have been well documented. As crack began to disappear from the headlines during the 1990s, however, it was assumed by many that crack had fallen on hard times in the street drug culture. Within this context, this article examines the extent to which crack has remained primary in the culture of cocaine-dependent women. Data are drawn from a study of 708 cocaine-dependent women in Miami, Florida, during the years 1994 to 1996, and qualitative data gathered during 1998 and 1999 in the same field areas. Analyses focus on drug use, criminality and HIV/AIDS risk behaviors. Implications for policy alternatives in criminal justice and public health approaches for assisting this population are discussed.

87 citations


Journal ArticleDOI
TL;DR: A look at the history of these compounds suggests that they have the potential to be used safely as psychotherapeutic tools, and that the legal status of MDMA and MDA may be worth reconsidering.
Abstract: In existence for nearly a century, 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") have gained quite a reputation. Perceived by some as dangerous neurotoxins, and by others as potential psychotherapeutics, these compounds have become a center of controversy among academics and law enforcement officials, and in the process have gained extensive media exposure. The classification of these drugs as illicit, controlled substances in the United States has not prevented their use, and MDMA, or Ecstasy, is currently one of the most popular substances used recreationally in North America. The scheduling of MDMA and MDA has, however, led to the distribution of contaminated, or falsely represented, Ecstasy tablets, and prevented responsible research into the detrimental and therapeutic effects of these drugs. A look at the history of these compounds suggests that they have the potential to be used safely as psychotherapeutic tools, and that the legal status of MDMA and MDA may be worth reconsidering.

75 citations


Journal ArticleDOI
TL;DR: It is concluded that patients with GHB or GBL withdrawal may present with agitated psychosis, delirium, and autonomic instability and relapse to GHB and GBL use occurred soon after treatment of withdrawal.
Abstract: There is little medical information available about gamma- hydroxybutyrate (GHB) or gamma-butyrolactone (GBL) dependence or withdrawal. In this study the authors treated and reviewed multiple cases of GHB and GBL withdrawal in high-dose users. Five patients during nine hospitalizations were treated for GHB or GBL withdrawal. The authors describe a spectrum of GHB or GBL withdrawal from mild to severe and discuss medications used for treatment. They conclude that patients with GHB or GBL withdrawal may present with agitated psychosis, delirium, and autonomic instability. In this sample, relapse to GHB or GBL use occurred soon after treatment of withdrawal.

74 citations


Journal ArticleDOI
TL;DR: A critical review of the research literature found that familial factors, peer influences, involvement with religious institutions, and after-school activities have a powerful impact on the drug-using behaviors of Hispanic child, youth and adult drug users.
Abstract: In this article the authors conducted a critical review of ongoing and recently completed drug abuse studies which have examined the importance of social support systems in the drug-using behavior of Hispanics Published and unpublished preliminary data from these studies are presented and discussed This critical review of the research literature supports earlier findings that social support systems play an important role in preventing drug abuse among Hispanics Specifically, this review found that familial factors, peer influences, involvement with religious institutions, and after-school activities have a powerful impact on the drug-using behaviors of Hispanic child, youth and adult drug users The authors suggest that drug prevention and treatment programs within Hispanic communities will be more successful if they incorporate social support systems into their programs In conclusion, the authors identify areas in which the role of social support systems in the drug-using behavior of Hispanics need further investigation

59 citations


Journal ArticleDOI
TL;DR: Analysis of saliva test results suggested that saliva may have some advantages over urine because of the ease of collection, invulnerability to adulteration, and minimal personal invasiveness, and a more comprehensive study to evaluate the efficacy of saliva testing in field research may be warranted.
Abstract: Past studies have concluded that individuals under criminal justice supervision often underreport their recent use of illicit drugs. To address this underreporting, objective biological measures, such as urine, saliva, and hair testing, have been used to gain better estimates of illegal drug use. While urinalysis is generally recognized as the reference standard, a method recently introduced in nonlaboratory settings for ascertaining drug use-saliva testing-may offer an alternative to urinalysis. To date, however, no studies have compared saliva testing to urinalysis among criminal justice populations. In the current study, urine and saliva specimens were collected from 114 adult arrestees interviewed as part of Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) project. With urinalysis as the reference standard, analysis of the saliva test results indicated sensitivity of 100% and specificity of 99% for cocaine and sensitivity of 88% and specificity of 100% for heroin. For marijuana, however, the saliva results indicated a sensitivity of only 5%. Anecdotal reports from the field suggest that saliva may have some advantages over urine because of the ease of collection, invulnerability to adulteration, and minimal personal invasiveness. These findings suggest that a more comprehensive study to evaluate the efficacy of saliva testing in field research may be warranted.

45 citations


Journal ArticleDOI
TL;DR: Psychoptic activity of bufotenine has been established and the 1967 Holmstedt–Lindgren hypothesis of the paricá effect—intranasal potentiation of tryptamines by concomitant administration of monoamine-oxidase-inhibiting (MAOI) β-carbolines from stems of Banisteriopsis caapi admixed with the snuffs—has been confirmed by 25 psychonautic bioassays.
Abstract: Summarized are psychonautic bioassays (human self-experiments) of pharmanopo—crystalline bufotenine (5-HO-DMT; 5-hydroxy-N,N-dimethyltryptamine; dimethylserotonine), at times combined with harmaline or harmine—via intranasal, sublingual, intrarectal, pulmonary (inhaled vapor) and oral routes. This is done by way of pharmacological modeling of diverse South American shamanic inebriants, principally the snuffs nopolyopo and cebihataj, prepared from seeds of Anadenanthera peregrina var. peregrina and A. colubrina var. Cebil, respectively. Psychoptic (visionary) activity of bufotenine has been established and the 1967 Holmstedt–Lindgren hypothesis of the parica effect—intranasal potentiation of tryptamines by concomitant administration of monoamine-oxidase-inhibiting (MAOI) β-carbolines from stems of Banisteriopsis caapi admixed with the snuffs—has been confirmed by 25 psychonautic bioassays. Salient phytochemical and psychonautic literature is reviewed, and isolation of bufotenine from Anadenanthera...

Journal ArticleDOI
TL;DR: An overview of trend theory represents it as an instance of agent-based adaptive models characteristic of complexity theory.
Abstract: Trend theory is an effort to integrate histories of populations and distribution systems to explain the key epidemiological question: why do these people in this place at this time experience a rapid increase in heroin use? The theory grew out of work on heroin trends in the Baltimore metropolitan area, specifically on epidemics among urban African-Americans in the 1960s and among suburban white youth in the 1990s. This overview represents trend theory as an instance of agent-based adaptive models characteristic of complexity theory.

Journal ArticleDOI
Patt Denning1
TL;DR: Harm reduction implementation includes a range of interventions including abstinence, and staff must find a way to respect each others' ideas and concerns as they develop new ways to implement harm reduction in work.
Abstract: Harm reduction is a set of strategies that we all use everyday to protect us from the harms of living in a complex world. Central to the principles of harm reduction is the need to respect the client's autonomy and develop a relationship of mutual collaboration with the goal of reducing drug- and alcohol-related harm. Additional principles stress the need to develop a hierarchy of client needs, a list that includes all other services, with the importance for each set by the client. Harm reduction implementation includes a range of interventions including abstinence. Some interventions are controversial, including needle exchange, but most are traditional health promotion activities such as videos, health fairs, and drug education. Essential to implementing harm reduction is a recognition that, even for those who wish to become abstinent, this goal is difficult to achieve and maintain. We must acknowledge this and stop the practice of imposing punitive sanctions on clients who use drugs while in treatment. Exclusion or expulsion from treatment settings does nothing to reduce drug use and greatly increases the harm to the client. In conclusion, just as we need to respect diversity among our clients, staff must find a way to respect each others' ideas and concerns as we develop new ways to implement harm reduction in our work.

Journal ArticleDOI
TL;DR: There has been a large increase in coca products use in Sāo Paulo from 1994 to 1999; concomitantly, there have been a decrease of hydrochloride use.
Abstract: The characteristics of coca products use in Sāo Paulo, Brazil during the years of 1994 and 1999 were investigated through interviews with 26 key informants (KIs; persons with knowledge of coca product users) in each of these years. The following information was yielded by the KIs: (1) there has been a large increase in coca products use in Sāo Paulo from 1994 to 1999; concomitantly, there has been a decrease of hydrochloride use; (2) the increase has occurred due to the dissemination of crack which became cheap and easily available; (3) reasons for crack use changed greatly: in 1994, use was attributed mostly to pleasurable sensations produced by smoking; in 1999, use was intended to overcome compulsion/dependence or to put up with frustration/family conflicts; (4) crack users in 1999 came from practically all social classes of Sāo Paulo; (5) use of alcohol and/or marijuana to cut down the anxiety and excitement produced by crack increased from 1994 to 1999; (6) even when police repression of tra...

Journal ArticleDOI
TL;DR: No significant differences were found between full responder and partial responder patients regarding changes in clinical features, alcohol intake or social adjustment, and patients still in treatment after one year significantly differed from nonresponder patients on all the variables investigated.
Abstract: Thirty-five alcohol-dependent patients according to DSM-IV criteria who also met criteria for treatment resistance were treated with doses of gamma hydroxybutyrate (GHB) ranging between 25 and 100 mg/kg/die in an open one-year study. The results show that no patients discontinued the program during the first month of treatment. Sixty percent of these patients successfully completed the protocol; 11.4% showed complete abstinence (full responder patients); 14.3% strongly reduced their alcohol intake (partial responder patients) and 34.3% of the patients were still under treatment after one year. Forty percent of the patients were nonresponders. The retention rate under treatment of the studied sample was statistically higher than that found during the last treatment of the same subjects. No significant differences were found between full responder and partial responder patients regarding changes in clinical features, alcohol intake or social adjustment. Patients still in treatment after one year significantly differed from nonresponder patients on all the variables investigated. A six-times/daily fractionated administration of the GHB dose was the only significant predictor of the retention rate.

Journal ArticleDOI
TL;DR: DVPX loading is well tolerated and may be efficacious in the treatment of cocaine dependence and a placebo-controlled trial would be of interest.
Abstract: The current pilot project was designed to evaluate the safety and tolerability of a loading dose of divalproex (DVPX) in subjects with cocaine dependence Seventeen cocaine-dependent subjects were enrolled in an eight-week, open-label trial of 20 mg/kg/day DVPX Subjects were seen weekly and urine drug screens were obtained at each visit Over the eight-week trial, craving intensity and frequency as well as reported time using cocaine decreased significantly Retention in the current study was 79% at week four and 50% at week eight The medication and dosing strategy was well tolerated This pilot study indicates that DVPX loading is well tolerated and may be efficacious in the treatment of cocaine dependence A placebo-controlled trial would be of interest

Journal ArticleDOI
TL;DR: Reports of recreational codeine cough syrup use have increased in Houston and in the state of Texas, and polydrug users reported a penchant for codeine syrup because it carries fewer legal consequences, is perceived as “safer than illegal drugs, and is either free or inexpensive for users with Medicaid or private insurance.
Abstract: Reports of recreational codeine cough syrup use have increased in Houston and in the state of Texas. Occasional and polydrug users increasingly have consumed codeine cough syrup (with or without alcohol or other drugs) over the past three years, accounting for a $40 increase in the price of an eight-ounce bottle on the underground economy. News stories regarding syrup abuse and reports of deaths by codeine overdoses suggested the need to explore this emerging drug trend. The investigator conducted a literature search of scientific journals and news media, interviews with community authorities, and guided interviews with 25 adults who reported using codeine cough syrup in the 30 days preceding their interviews. Participants were recruited through snowball sampling; interview transcripts were coded and content analyzed. Polydrug users reported a penchant for codeine syrup because it carries fewer legal consequences, is perceived as "safer" than illegal drugs, and is either free or inexpensive for users with Medicaid or private insurance. Participants reported methods for procuring syrup from physicians and hospital emergency rooms which they consumed or traded for money, goods, or services. Consumption patterns for chronic and occasional users are described. Reported side effects include a drowsy relaxed high, fatigue, loss of coordination, constipation, and urinary retention.

Journal ArticleDOI
TL;DR: A review of California drug court evaluations through January 2000 conducted as part of an evaluation of the Drug Court Partnership Program finds that drug court participants may experience reduced rearrest rates by 11% to 14% compared to nonparticipants.
Abstract: Over the past two decades, drug courts have emerged as a viable alternative for addressing drug cases within the criminal justice system. In California, the Drug Court Partnership Program (DCPP) was created in 1998 and has supported and funded the development of drug courts throughout the State. This article reports on a review of California drug court evaluations through January 2000 conducted as part of an evaluation of the California DCPP. A total of 23 evaluations were collected. Seventeen were reviewed in detail, and six were excluded because they were internal reports rather than evaluations. A standardized review process was initiated which led to a scored rating of the evaluation reports. Results of this review support previous findings that drug court participants may experience reduced rearrest rates by 11% to 14% compared to nonparticipants. The largest reduction in rearrest rates appears among graduates. The graduation rates were between 19% and 54%. Costs and savings associated with drug courts were discussed but no conclusions were possible based on the findings from these evaluations. The evaluation of the effectiveness of drug courts presents unique challenges. This review concludes with a discussion of evaluation methods (e.g. standardizing rate calculations, term definitions) that would strengthen drug court research.

Journal ArticleDOI
TL;DR: Subjects eligible for treatment, as indicated by a DSM-III-R diagnosis of cocaine dependency, were nearly four times as likely to admit current cocaine use than those who were not dependent.
Abstract: Detection of current (past 30 days) drug use by analysis of hair was examined along with self-reports of current use in a 1994 treatment needs assessment survey; the sample was 179 homeless/transient adults in New York state. Results of radioimmunoassay of hair (RIAH) were used to eval uate the veracity of self-reports of current cocaine use. Only 26% of those persons whose hair tested positive for cocaine (n=115) admitted to having used cocaine in the past 30 days. Subjects eligible for treatment, as indicated by a DSM-III-R diagnosis of cocaine dependency, were nearly four times as likely to admit current cocaine use than those who were not dependent. These results are consistent with other studies of populations at high risk for substance use.

Journal ArticleDOI
TL;DR: The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder.
Abstract: Over the last 10 years, Europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.

Journal ArticleDOI
TL;DR: This study compared the relative impact of five treatment modalities—residential, outpatient, residential/outpatient, methadone and detoxification-only—on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusells between 1992 and 1997.
Abstract: During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities—residential, outpatient, residential/outpatient, methadone and detoxification-only—on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusells between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the ...

Journal ArticleDOI
TL;DR: It is suggested that one reason for this lack of attention is due to the failure of drug abuse treatment providers and researchers to see race as a cultural rather than physical phenomenon.
Abstract: African-Americans are overrepresented among drug abusers in the United States when compared to European-Americans, and have lower rates of recovery from drug addiction after treatment. There has been no comprehensive research to date to specifically explain either this overrepresentation or lower rates of recovery among African-Americans. In this article, it is suggested that one reason for this lack of attention is due to the failure of drug abuse treatment providers and researchers to see race as a cultural rather than physical phenomenon. The point is made that cultural factors are intrinsic to successful efforts to address drug abuse among African-Americans. Several historic African-American coping strategies are outlined and shown to be powerful factors in client addictive behavior and barriers to recovery. Through case studies of clients who were successful in their effort to recover, the necessity to address cultural as well as personal issues is shown to be vital to successful recovery among African-Americans.

Journal ArticleDOI
TL;DR: It is concluded that as heroin produces fewer side effects it is the preferred highdose maintenance prescription to morphine, and the perceived euphoric effects are limited in both substances.
Abstract: The purpose of this study is to evaluate the effects of high doses of injected opiates as prescribed maintenance in intravenous drugs users. This was accomplished via a randomised double-blind study with crossover at an outpatient clinic in Bern, Switzerland. The subjects were 39 patients with a long history of intravenous opioid use and persistent abuse despite treatment; they were randomly allocated to two groups. Group A was started on controlled injection of graduated doses of morphine up to a satisfying individual dose and was then switched as a double blind to heroin at a randomly determined day between week three and four. Subsequently this group was given heroin for the remaining two to three weeks of the study. Group B was started on heroin and was then switched to morphine in the same manner. Equipotent solutions of 3% morphine and 2% heroin were administered. The main outcome measures were clinical observations, structural interviews and self report of subjective experiences to assess the effects of the drugs. In 16 cases, the study had to be discontinued owing to severe morphine-induced histamine reactions. Thirteen participants in Group B presented these adverse reactions on the day of the switch-over. Full data were thus only obtainable for 17 participants. Average daily doses were 491 mg for heroin and 597 mg for morphine. The findings indicate that heroin significantly produced a lower grade of itching, flushing, urticaria and pain/nausea. A negative correlation between dose and euphoria was observed for both heroin and morphine. The authors concluded that as heroin produces fewer side effects it is the preferred high-dose maintenance prescription to morphine. The perceived euphoric effects are limited in both substances.

Journal ArticleDOI
TL;DR: It is suggested that painless detoxification from heroin can be obtained by a single high dose of buprenorphine, following heroin abstinence of 24 hours.
Abstract: To test the effect of 32 mg of buprenorphine on the withdrawal process from heroin, 10 street-heroin using subjects were given 32 mg of sublingual buprenorphine, following heroin abstinence of 24 hours. Withdrawal symptoms were monitored during the first few hours, and followed for six days after buprenorphine administration, after which naltrexone (50 mg) was introduced to prevent future heroin use. Nine subjects completed detoxification with negligible withdrawal symptoms and a smooth transition to naltrexone. One subject was excluded from the study due to methadone ingestion prior to experiment. These results strongly suggest that painless detoxification from heroin can be obtained by a single high dose of buprenorphine.

Journal ArticleDOI
TL;DR: A formalized system for applying some of the main principles of harm reduction within the treatment system, called substance use management (SUM), as it no longer requires abstinence but instead focuses on a range of options for improvements while still including abstinence among the possible selfselected outcomes.
Abstract: Disease (particularly HIV) has increased our motivation to reconsider how the current help system deals with drug-related problems. A more concrete focus on disease prevention as an additional goal has, for many, lead to a reevaluation of the goals of drug help work. Such a critical examination shows how much there is to improve within the system even in the absence of blood borne disease. Integrating the heart of harm reduction—respecting work on any positive change as a person defines it for his/herself—into treatment fashions a health sensitive alternative to the predominant practice of abstinence-only assistance for the relief of drug problems. This new approach is called substance use management (SUM), as it no longer requires abstinence but instead focuses on a range of options for improvements while still including abstinence among the possible selfselected outcomes. SUM is suggested as a framework for change within the treatment system that would maximize treatment's constructive impact, ...

Journal ArticleDOI
TL;DR: An example-anchored rating scale to operationalize codependency as substance abuse counselors construe it in practice is developed and it is suggested that the rating scale yields reliable and valid evaluations of codependencies without appreciable gender bias.
Abstract: This investigation examined the reliability and validity of a rating scale for codependency in substance abuse treatment. The investigators developed an example-anchored rating scale to operationalize codependency as substance abuse counselors construe it in practice, and recruited 27 counselors for a counterbalanced multiple-treatment experiment. Counselors were randomly assigned to one of four continuing education workshops for rating-scale training, and asked to evaluate codependency in five videotaped cases. Semistructured case interviews were videotaped with a male and a female from five adult populations to vary the gender and codependency of cases: (1) outpatients in treatment for addiction, (2) outpatient spouses, (3) members of Codependents Anonymous, (4) United States Bureau of Land Management smoke jumpers, and (5) college students majoring in business or economics. To control for gender effects, one workshop presented male cases, one workshop presented female cases, and two workshops presented cases of both genders. To control for order effects, the assignment of videotapes to workshops was randomized to counterbalance the order in which counselors viewed them. The findings suggest that the rating scale yields reliable and valid evaluations of codependency without appreciable gender bias.

Journal ArticleDOI
TL;DR: By giving voice to Nigerian drug users, this article is an attempt to dispel some misconceptions about drug use and abuse, and to widen the debate surrounding African drug control.
Abstract: One of the consequences of increased exposure to Western influences has been the spread of drug use among Nigerian young people over the last two decades. There is now a buoyant consumer market for home-grown cannabis, and a smaller market for heroin and cocaine within the country. Under successive military regimes, drug use was either downplayed, or regarded as a law enforcement issue. Little work was carried out to gauge the extent of use, or obtain an understanding of the user constituencies. Government policies are entirely informed by Western models and sadly inadequate in understanding Nigerian drug trends and in devising schemes to meet local needs. This article, by giving voice to Nigerian drug users, is an attempt to dispel some misconceptions about drug use and abuse, and to widen the debate surrounding African drug control. There is a grave danger of the war on drugs being exported to African countries where civil societies are weakest in withstanding the onslaught of government and international agencies. This article is therefore an ethnographic drugs study engaging with crucial development issues.

Journal ArticleDOI
TL;DR: Overall, much stronger associations with parenting outcomes were found for an index of maternal vocabulary, compared with maternal psychological distress or maternal alcohol and other drug use.
Abstract: This study examines associations between psychological distress and alcohol and drug use across the first 5 years of raising a child and parenting quality at child age 6 for 185 adolescent mothers. Overall alcohol and other drug use in this sample was relatively low but drug use was associated with more mother- reported unrealistic expectations of child behavior and more attributions of child intent to annoy parent by misbehaving. Maternal psychological distress was associated with maternal reports of negative control (yelling pushing spanking etc.) and alcohol use moderated the association between psychological distress and negative control. At low levels of alcohol use more maternal distress was associated with greater negative control; at higher levels of alcohol use maternal distress was not related to negative control but the absolute level of negative control was similar to that reported by more distressed mothers. Neither psychological distress nor alcohol and other drug use were related to maternal behavior during an interaction task. Overall much stronger associations with parenting outcomes were found for an index of maternal vocabulary compared with maternal psychological distress or maternal alcohol and other drug use. (authors)

Journal ArticleDOI
TL;DR: Harm reduction, an approach to treating drug-using clients that focuses on the damage done by drugs and alcohol without insisting on abstinence from all psychoactive substances, can offer a useful way of conceptualizing treatment of dual diagnosis.
Abstract: Up to 80% of people with mental and emotional disorders have abused or will abuse street drugs or alcohol at some point in their lives. Similarly, over half of people with substance use disorders are also diagnosed with a mental disorder at some point. In clinical populations and institutional settings, the numbers are far higher. The term dual diagnosis (coexisting mental and substance use disorders) refers to a large and complex group of people. This article addresses general issues regarding the complexities of dual diagnosis--differential diagnosis, the difficulty of achieving abstinence for people who perceive significant benefits from drug use, and the problems due to the historical split between the mental health and substance abuse treatment systems. Harm reduction, an approach to treating drug-using clients that focuses on the damage done by drugs and alcohol without insisting on abstinence from all psychoactive substances, can offer a useful way of conceptualizing treatment of dual diagnosis. A treatment group specifically designed for dually diagnosed clients is described. This group, inspired by the idea that changes in addictive behavior occur in a series of stages and that motivation can be influenced by the quality of the relationship with the treatment provider, uses a drop-in structure to provide low-threshold access to supportive treatment, to meet clients "where they are."

Journal ArticleDOI
TL;DR: Preliminary data suggest that ECM may be an effective intervention strategy to help chronically unemployed methadone clients obtain and maintain employment.
Abstract: Employment interventions implemented in drug treatment programs have been marginally successful, but few interventions have been found to address the needs of chronically unemployed clients. Employment case management (ECM) is a comprehensive employment intervention strategy designed to motivate chronically unemployed persons to engage in work, assist in job placement, and provide post employment support through workforce integration, while maintaining progress in drug treatment. This clinical case study reports on a convenience sample of 10 chronically unemployed methadone maintained clients who voluntarily enrolled in the ECM project. Clients received individual ECM services for a period of 26 weeks. Clients were assessed at two- and eight-month follow-up intervals. Nine of the 10 clients were employed at the two-month follow-up assessment and six maintained employment at the eight-month follow-up. Moreover, three clients were able to successfully transition from welfare to competitive private sector employment. Preliminary data suggest that ECM may be an effective intervention strategy to help chronically unemployed methadone clients obtain and maintain employment. Qualitatively, clients reported that post employment intervention services such as motivational counseling, problem solving, and employer advocacy helped sustain employment.